Public Health contribution towards LTC
Year of Care Commissioning Model
Dr Abraham P. George
Consultant / Asst Director in Public Health
Kent County Council
What is the LTC Year of Care
Commissioning Model?
“Shifting the focus away from reactive episodic
care, towards a proactive person centred capitated
funding model, irrespective of organisational
boundaries and disease based pathways of care”
What does the programme
involve?
-
Currently in Year 3
5 sites across England
Multi-centre hospital bed audit on ‘RRR’
Analysis of service utilization of multi-morbid
patients across all care settings
Test-proof / shadow new currencies
Evaluate local integrated care models
Data quality improvement
Design local data sharing arrangements
Local Profile
• >1.5 million population
• Governance of
commissioning at multiple
levels
• 1 County Council, 7
CCGs, 12 districts, 4
acute trusts, 1 community
health trust, mental health
trust, >200 practices
• Public Health
Observatory team
• Well networked with other
intelligence teams
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–
–
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JSNA development
Health & Social Care Maps
Local needs assessments
Other analyses
Public Health involvement till
date
• Work started in 2012 – QIPP LTC programme
• Whole population profiling using risk stratification
– Burden of multiple morbidities
– Impact on service utilisation - ‘Crisis curve’
– Modelling how benefits of integrated care could be realised
• Delivery of national YOC programme in Kent implementation at sub Kent / CCG level
• Submission of linked datasets to national team for analysis
• Contribution to national guidance eg. MONITOR report of
designing linked datasets
• Currently working health informatics service to develop
dashboard
Kent whole population dataset
report
http://www.nhsiq.nhs.uk/resource-search/publications/population-levelcommissioning-for-the-future.aspx
Key Challenges
• Information Governance is a key challenge
– Current approach to data sharing has been difficult –
different expert opinions on how share / link data
– National policy on data sharing for ‘indirect care’ is
evolving eg. role of ‘DSCROs’, Department Health
consultation on ‘Accredited Safe Havens’
• Data quality and accessibility
– Good support from provider organisations
– Quality / completeness of data variable across different
organisations
• Commissioner buy-in
– Still some way off in application toward CCG plans
– Difficult to change mind-set of commissioning capacity
towards outcomes.
Vision for integrated
intelligence
• Map data available from rest of public sector orgns
and services beyond NHS – housing, police, fire &
rescue, education
• Working with partners – changing and mind set
about ‘evidence based investment / disinvestment’
• Harness skills and expertise from local intelligence
teams
• Develop technical solutions for IT architecture,
‘safe haven arrangements’, system modelling tools
Further contact details
abraham.george@kent.gov.uk
fionuala.bonnar@kent.gov.uk
Beverley.Matthews@NHSIQ.nhs.uk